Friday, July 29, 2005

Suckers

I've always had it in my head that doctors are generally blind to clinical outcomes. Doctors diagnose a problem, but we really don't know how bad that problem is in this particular patient. Like RA for example. I've seen people with clear cut RA go on and do well over 10 years and longer. Others I've seen with terrible outcomes within a few years.

After doctors diagnose a problem, we usually make treatment plans. And we usually try to treat the underlying problem. RA is an autoimmune disorder that gives rise to pain and decreased functionality of the hands. So instead of only treating pain and giving wrist spints/ortho procedures, it makes good sense to treat the autoimmune disease with various immunomodulatory drugs.

I've always thought that we needed big trials to see the difference. And I still do beleive this, but I will have to revise my example, which was the mighty medical leech. I had always made fun of doctors who thought that using leeches was good medicine, using it to show that doctors have no clue what they are doing without a trial. Back in the day, it should be noted, that medical dogma held that disease resulted from imbalance from the 4 humors. So that hot, or increased blood diseases, could be helped by decreasing this humor - through bleeding, or through the leech.

The fact is that we do the same thing now, but we have more humors: cholesterol, blood pressure, glucose, amyloid, antibodies, T-cells, and the like. If high, we make low. If low, we make higher.

But now the latest New Yorker has an article on the uses of the lovely medical leech.

9 Comments:

I say "no" to leeches...unless of course, they make me feel good. Then I say "yea" to leeches. I just wont look as they're put into place. Ick blech pooh.

You know all this, but I need to say it for the people of the internet:

RA means the immune system recongizes the synovial tissue as not belonging there and attacks and gets rid of it until bone on bone fusion occurs. Mmmm yummy.)

It could occur anywhere in the body and everywhere. (jaw, cervical and thorasic spine, hips, knees, ankles, toes, elbows, shoulders yada yada yada.) It's not necessarily symmetrical and it doesn't necessarily manifest with a lot of swelling and obvious inflammation. Like my friend, the hands could be pretty okay.

It's typically treated with disease modifying drugs and anti-inflammatories most recently the cox2 inhibitors that are SADLY receeding from the shelves.

A combination treatment is the best. if tolerated. The disease modifiers known as biologicals are a great but the issue of tenacious infections and fevers etc. really suck. The older options such as the immune depressing chemo drug methotrexate scare me more. Gold is very iffy and many are highly allergic to it... So what's left these days?

Nuttin' much honey.

Does it seem like we're no further along than the medical stone ages? Or is that just me.

Just don't tell my friend to take a Tylenol or she may go postal on your ass. ("Hey, you have a massive head wound! Here. Take this Tylenol." See? With blood, it just doesn't happen that way.)

People like to see blood and guts with their pain. Sadly, some of the worst pain doesn't coincide with a visual cue.

Sorry for the attack of schizothemia. Thanks for the rant space Doc. You're a pretty all right kind of doc.

I've had success with treating RA in that I've been able to relieve (even for a couple days) some of the muscular pain and tightness.

Usually I see a patient with an autoimmune disease after they've exhausted most convential routes. I don't care about that ~ as long as I can give some relief, I'm just glad they find me.

In Chinese medicine I bleed people although not with leeches. My bleeding technique involved a lancet needle and I will bleed a patient to release heat from the body, usually when there has been an acute injury or a migraine.

Most patients aren't happy when I say I want to bleed them. Most will allow me to because they are in pain and the results have been pretty incredible, even when I've been skeptical. The relief(especially with a migraine) can be almost immediate.